KODY C LEWIS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085003466

License Status

NOT RENEWED

Business

First Name

KODY

Middle

Last Name

LEWIS

Business Name

KODY C LEWIS

Original Issue Date

06/10/2009

Effective Date

01/10/2022

Expiration Date

03/01/2024

City

OCONOMOWOC

State

Zip

53066

Ever Disciplined

LastModifiedDate

02/05/2025